The toll of America’s obesity epidemic is showing up in younger women, as a new study shows that deaths from heart disease in this unlikely group have increased in the past decade.
The likely culprits along with obesity? Type 2 diabetes, along with diseases of pregnancy, such as preeclampsia and preterm delivery, researchers said.
“Cardiovascular disease mortality is going up in younger women, and if it continues at this rate, it may overtake cancer as the leading cause of death in young women,” said senior researcher Dr. Erin Michos, an associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Although heart disease is the leading cause of death worldwide, cancer has been the main cause of death among young women in the United States. For the study, researchers used death certificates to compare deaths from cancer with deaths from heart disease in women under age 65 between 1999 and 2018.
Over that time, death rates for cancer and heart disease were 53 and 24 people per 100,000, respectively. The most common cause of heart disease death was heart failure (56%), while respiratory and lung cancer (23%) was the main cause of cancer death.
Although cancer deaths declined throughout the study period, heart disease death rates fell initially and then increased again between 2010 and 2018, the researchers found.
The death gap between cancer and heart disease decreased from 33 to 23 per 100,000 per year, the researchers noted.
The report was published Feb. 10 in the European Heart Journal – Quality of Care and Clinical Outcomes.
Michos said that younger women have to advocate for their own health. They need to know their blood pressure, cholesterol and blood sugar levels, and they need to make sure they are getting treatment for these and other risk factors for heart disease.
“Also, I really encourage women to discuss their pregnancy histories with their doctors,” Michos said. “We know that women who’ve had a history of preeclampsia or gestational diabetes or preterm delivery are at increased risk for cardiovascular disease. Many women don’t realize that a history of preeclampsia makes them more vulnerable to heart disease a decade after their pregnancy.
“Also, women who go through menopause early, before age 45, are at increased risk of heart disease,” she added.
Doctors also need to take young women’s heart health seriously, Michos noted.
“There’s still this misconception that women are at lower risk, especially if they’re before menopause. But this isn’t necessarily true — lower risk doesn’t mean no risk,” she said. “I think both doctors and women clearly underestimate the risk.”
Dr. Suzanne Steinbaum, from the Juhi-Ash Integrative Health Center in New York City and a spokesperson for the American Heart Association, said that increased stress may be driving obesity and other factors linked with the increase in heart disease in younger women.
“Stress is leading to an increase in risk factors, such as diabetes, obesity, high cholesterol and high blood pressure,” said Steinbaum, who wasn’t part of the study. “Women are not able to take care of themselves — they’re last on the list, and what this results in is what we know and have talked about for many years, which is women get heart disease.”
She said that progress has been made in taking women’s heart health seriously, but there is still a long way to go.
“There are definite disparities in care, there’s an unconscious bias, which exists for all women and more specifically for women of color,” Steinbaum said. “There’s research that shows women who go into the emergency room have a delay in their treatment by as much as 30%. Women who present with heart attacks are less likely to receive lifesaving treatments and medications. And we know that women who see women doctors are more likely to do better.”
Women need to advocate for themselves, Steinbaum stressed.
“I’m afraid that not all doctors have the knowledge base and the wherewithal to really understand what to do with women when these [heart] risk factors exist,” she said.
For more on women’s heart health, see Go Red For Women.
SOURCES: Erin Michos, MD, associate professor, medicine, Johns Hopkins University School of Medicine, Baltimore; Suzanne Steinbaum, DO, Juhi-Ash Integrative Health Center, New York City, and spokesperson, American Heart Association; European Heart Journal – Quality of Care and Clinical Outcomes, Feb. 10, 2021